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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623657
Report Date: 02/19/2025
Date Signed: 02/19/2025 09:19:12 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2024 and conducted by Evaluator Josiah Gathing
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240729095845
FACILITY NAME:NIKBEEN, MARZIAFACILITY NUMBER:
343623657
ADMINISTRATOR:NIKBEEN, MARZIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 835-2948
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:14CENSUS: 0DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:N/ATIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Lack of proper supervision resulted in child sustaining a fractured hand
Lack of proper supervision resulted in child sustaining a black eye
Licensee did not seek timely medical attention for child
Licensee did not properly report injury
INVESTIGATION FINDINGS:
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On Wednesday, February 19 2025, at approximately 9:00 AM Licensing Program Analyst (LPA) Josiah Gathing submitted investigation findings to Family Child Care Home #343623657 via certified mail. It was alleged that lack of proper supervision resulted in child sustaining a fractured hand, lack of proper supervision resulted in child sustaining a black eye, licensee did not seek timely medical attention for child, and licensee did not properly report injury. LPA reviewed reports by Investigator Andrew Murrow from the Department's Investigations Branch and did not find them sufficient to prove or disprove the allegations.
Although the alleged violations may have happened or are valid, the preponderance of evidence standard has not been met to fully prove or disprove that they did or did not occur, therefore, they are unsubstantiated. This report as well as appeal rights were printed and sent via certified mail to the facility address.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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